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（6）血浆置换 可能通过去除抗体和免疫循环复合物而起效，在其他药物治疗无效时可试行血浆置换疗法。
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（7）眶部放疗和手术 对重度进行性的GO, 可施行眶部放疗、眶内减压等手术。
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（8）同位素治疗与GO 几个早期的前瞻性研究发现甲亢患者131Ⅰ治疗使甲状腺眼病加重较甲状腺次全切除或抗甲状腺药物治疗更常见。最近的随机研究比较了他巴唑与131Ⅰ治疗，3个月糖皮质激素治疗或不治疗对轻度甲状腺眼病的影响。结果发现，131Ⅰ治疗组有32％的患者眼病恶化或发生眼病，他巴唑治疗组5.3％眼病恶化或发生眼病。131Ⅰ治疗同时加服强的松治疗组〔0.4～0.5mg/(kg·d)〕，在放疗后2～3d开始，持续1个月，然后在2个月内停用）则无1例眼病恶化或发生眼病。但也有131Ⅰ治疗后眼病减轻的报道。EUGOGO推荐131Ⅰ治疗后1～3d开始加服强的松治疗（prophylactic steroid cover）0.3～0.5mg/(kg·d)，然后在3个月内停用，1～2个月的治疗也可能同样有效，认为该方案可将同位素治疗后15％左右的突眼加重比例降至几乎为零。
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【思考题】
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1．TRAb在GD诊断中的价值如何？
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2．试述Grave病治疗新进展。
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参考文献
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[1] Prabhakar BS, Bahn RS, Smith TJ. Current perspective on the pathogenesis of Graves disease and ophthalmopathy. Endocrine Reciew, 2003, 24(6)
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[2] Vaidya B, Pearce S. The emerging role of the CTLA4 gene in autoimmune endocrinopathies. Eur J Endocrinol, 2004, 15(5)
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[3] Davies TF. Infection and autoimmune thyroid disease. J Clin Endocrinol Metab, 2008; 93(3)
:674-676.
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[4] Kondrashova A, Viskari H, Haapala AM, et al. Serological evidence of thyroid autoimmunity among schoolchildren in two different socioeconomic environments. J Clin Endocrinol Metab, 2008; 93(3)
:729-734.
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[5] Ginsberg J. Diagnosis and management of Graves disease. CMAJ, 2003; 168(2)
:575-585.
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[6] Orgiazzi J, Madec AM. Reduction of the risk of relapse after withdrawal of medical therapy for Graves disease. Thyroid, 2002, 12(10)
:849-853.
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[7] Chang TC, Liao SL. Slow-release lanreotide in Graves’ ophthalmopathy: A double-blind randomized, placebo-controlled clinical trial. J Endocrinol Invest, 2006, 29(5)
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[8] Stan MN, Garrity JA, Bradley EA, et al. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves’ ophthalmopathy. J Clin Endocrin Metab, 2006, 91(12)
:4817-4824.
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[9] Kahaly GJ, Pitz S, Hommel G, et al. Randomized, single-blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab, 2005, 90(9)
:5234-5240.
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[10] Bartalena L, Baldeschi L, Dickinson AJ, et al. Consensus statement of the European group on Graves’ orbitopathy（EUGOGO）on management of Graves’ orbitopathy. Thyroid, 2008, 18(3)
:333-346.
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（李红 董雪红）
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内科学新进展 第二节 骨质疏松症防治进展
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摘 要 骨质疏松症（osteoporosis, OP）是一种以低骨量和骨组织微结构破坏为特征，导致骨骼脆性增加和易发生骨折的代谢性疾病。OP分为三大类：原发性骨质疏松（又分为Ⅰ型绝经后骨质疏松、Ⅱ型老年性骨质疏松）、继发性骨质疏松和特发性骨质疏松。预防OP包括危险因素评估与筛查、预防骨折等。药物治疗方面包括补充钙和维生素D、二膦酸盐（阿伦膦酸盐、利塞膦酸盐、伊班膦酸盐）、雌激素及其受体调节剂、降钙素、甲状旁腺素（PTH）等，其他药物包括氟化物、依普拉芬、维生素K、锶盐等。目前临床上可以两药联合或者多药联合应用，如ADFR, 即活化激活骨重建、抑制骨吸收、在无干扰下进行新骨形成、重复上述过程，通过外来药物干预达到骨重建的重循环同步。
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Abstract A systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture risk. It includes three types: primarily osteoporosis（including type 1 postmenopausal osteoporosis, PMO, and type 2 senile osteoporosis), secondarily osteoporosis, and idiopathic osteoporosis. The preventing ways consist of evaluating risk factors and screening high-risk group, to avoid fracture and so on. Medication contains that supplement of calcium agent and vitamin D, bisphosphonates（alendronate, risedronate, ibandronate), estrogen and selective estrogen receptor modulators（SERMs), calcitionin, parathyroid hormone（PTH). Others include that fluorid, ipriflavone, vitamin K, strontium chloride and so on. In clinical two or more drugs can be applicated together, such as ADFR（activation, depress, free, repeat).
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骨质疏松症是一种常见的骨骼疾病。随着世界人口的增加和平均寿命的提高，这种疾病的威胁也越来越大。在中国，50岁以上的女性中，每3人便有1人受骨质疏松症威胁，而骨质疏松患者一旦出现骨折，只有不到1/3女性骨折患者能恢复她们先前的活动能力，而超过1/3患者会因终生残疾而需要持续的护理。随着人口的老龄化，骨质疏松症已跃居常见病、多发病的第7位，严重危害广大中老年人的健康和生活质量。现就近年来骨质疏松症的防治进展做一综述。
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一、定义与分类
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